Tobacco and heart disease: The disastrous link

Dr. Dharmakanta Kumbhakar

(The writer can be reached at drkdharmakanta@yahoo.com)

According to the World Health Organization (WHO), cardiovascular disease (CVD) is one of the leading causes of death worldwide, and tobacco use and second-hand smoke exposure contribute to approximately 12 percent of all heart disease deaths. Tobacco use is the second leading cause of heart disease after high blood pressure. Despite the known harms of tobacco to heart health and the availability of solutions to reduce related deaths and disease, knowledge among a large section of the public that tobacco is one of the leading causes of CVD is low.

Tobacco increases the risk of developing CVD, which includes coronary heart disease (CHD), heart attacks, hypertensive heart disease, stroke, peripheral arterial disease (PAD), etc. Whether tobacco is chewed or smoked, it damages blood vessels, temporarily raises blood pressure, and lowers exercise tolerance. Tobacco increases the tendency for blood to clot. Blood clots in the arteries can further cause a range of heart problems, which ultimately result in a stroke or sudden death. Chewing tobacco or snuff may be less dangerous than smoking tobacco, but eventually, after long-term use, they too lead to grave heart problems.

Smoking tobacco, including cigarettes, cigars, and pipes, as well as shisha (hookah), has a devastating impact on our cardiovascular health. Smoking tobacco actually triples the risk of dying from heart disease. Every cigarette we smoke and/or every session of shisha we do, make us more likely to get heart disease. The WHO points out that the total volume of smoke inhaled during an hour-long session of shisha is equivalent to smoking 100 to 150 cigarettes. About 30 percent of all heart disease deaths worldwide are directly related to tobacco smoking. Contrary to public perception, smoking-caused heart disease actually results in more deaths per year than smoking-caused lung cancer. When it comes to heart disease prevention, no amount of smoking is safe. Even smoking occasionally increases the risk of heart disease. People who quit smoking dramatically reduce their risk of dying from heart disease. The body begins to repair itself almost immediately. No matter how long or how much one smoked, will start reaping rewards as soon as one quits. Quitting smoking can help people who already have heart disease. People who quit smoking can cut their risk of having another heart attack or dying of heart disease in half. When a smoker quits, the risk of dying from heart disease begins to fall almost immediately, but it takes 15 years for the risk to approach that of a non-smoker.

Tobacco smoke contains high levels of carbon monoxide, which in turn affects the heart (increase in heart beat) by reducing the amount of oxygen the blood can carry to other parts of the body. The nicotine present in tobacco smoke causes an increase in heart rate and blood pressure. Over time, these cause extraordinary “wear and tear” on the cardiovascular system. Chemicals in tobacco smoke can form atherosclerosis in the coronary arteries, leading to narrowing of the coronary arteries and thus restrict the blood flow to the heart. Atherosclerosis makes the heart work harder, increasing heart rate and blood pressure to get sufficient oxygen and nutrition. When one or more of the coronary arteries are completely blocked, a heart attack (injury to the heart muscle, or myocardial infarction), may occur. Cigarette smoking is a multiplicative risk factor, along with hypertension and hypercholesterolemia, for development of CHD and arteriosclerosis. It is also a multiplicative risk factor for myocardial infarction and stroke in women who take oral contraceptives. Cigarette smoking is a major cause of stroke by activating clotting factors, decreasing HDL cholesterol levels, increasing triglyceride levels, and damaging the lining of blood vessels. Smoking tobacco causes thrombus formation by increasing platelet adhesion and aggregation, which can impact blood circulation, particularly in the hands and feet, and result in gangrene and eventually amputation. In addition to the heart health hazards of mainstream tobacco smokes, there are risks associated with exposure to side stream smoke, also called passive smoking or environment tobacco smoke (ETS). Research shows that ETS increases the risk of ischemic heart disease and myocardial infarction. Non-smokers living with and around smokers have a 30% higher risk of acquiring heart disease.

The burden of tobacco-related heart disease and death is high in India. There is a significant economic burden in India due to resources invested in healthcare to treat tobacco-related heart diseases. Besides the treatment-related expenditure, the indirect costs due to absence from work, premature death, the loss of a working family member, etc., constitute a greater burden on the nation. Smoking is now the most identifiable risk factor for heart attacks among young people in India. A report from the AIIMS, New Delhi, indicates that in India, 76 percent of young heart attack victims are smokers. As tobacco-related heart diseases are preventable by quitting tobacco consumption, the Government and NGOs should offer medical (such as nicotine replacement therapy, behavioural therapy, etc.) and social help to the smokers to quit tobacco smoking. One should try to quit smoking on his own to get rid of tobacco-related heart disease and death. The government must protect people from exposure to tobacco smoke by creating completely smoke-free indoor public places, workplaces, and public transport. The government should implement harsh anti-tobacco laws and ban tobacco advertising, promotion, and sponsorship. The tax on tobacco should be increased to make it less affordable. Vigorous campaigns focusing on the health hazards of tobacco consumption and highlighting the bountiful benefits once the habit is kicked are the need of the hour.